title: The long-term coronary heart disease risk of previously obese patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Obesity is associated with insulin resistance, development of diabetes, and coronary heart disease. There is limited information on the contribution of previous obesity on the risk of coronary heart disease. We aimed to examine the effect of previous history of obesity on the occurrence of coronary heart disease in patients with diabetes.
  
  
  METHODS
  We carried out a retrospective chart analysis of 315 type 2 diabetic patients without obesity and without atherosclerotic cardiovascular events at their initial hospital visit (men/women 236/79; mean ± standard deviation; age 53.1 ± 6.6 years; maximal body mass index before enrollment (MAXBMI) 26.6 ± 3.4 kg/m2; decrease of the BMI at enrollment from MAXBMI (deltaBMI) 4.23 ± 2.62 kg/m2) to investigate the association of previous obesity (MAXBMI larger than 30 kg/m2) with the long-term incidence of cardiovascular events. Of 315 patients, forty-eight were previously obese.
  
  
  RESULTS
  After median follow-up of 13.9 years, 48 patients developed coronary heart disease. The Kaplan-Meier analysis exhibited that coronary heart disease occurred more frequently in previously obese patients than in subjects in the reference category (22 kg/m2 < or = MAXBMI < 25 kg/m2) and that the effect lasted proportionally over follow-up periods. Multivariate Cox regression models showed that hazard ratios and corresponding 95% confidence intervals of coronary heart disease for patients with previous obesity compared with subjects in the reference category were 2.52 and 1.15 to 5.50 (p value = 0.020) after adjustment for age, sex, smoking status, systolic blood pressure, total cholesterol and HDL cholesterol. In this cohort, deltaBMI strongly correlated with MAXBMI and also behaved as a risk factor. The hazard ratios and 95% confidence intervals by the increment of one standard deviation of deltaBMI after adjustment for age, sex, smoking status, systolic blood pressure, total cholesterol and HDL cholesterol were 1.38 and 1.08 to 1.79 (p value = 0.013).
  
  
  CONCLUSIONS
  Previous obesity and/or large body weight loss before admission might act as an increased risk for coronary heart disease.
authors.affiliation: Department of Diabetes and Metabolic Medicine and Diabetes Research Center, National Center for Global Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. rithonda@hosp.ncgm.go.jp.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamamoto-Honda
authors.forename: Hideki
authors.initials: H
authors.lastname: Ehara
authors.forename: Hiroji
authors.initials: H
authors.lastname: Kitazato
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shoji
authors.initials: S
authors.lastname: Kawazu
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Akanuma
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Noda